Chapter 9 - Schizophrenia Flashcards
What are some common misconceptions about schizophrenia?
- means someone has two personalities
2. that they are violent
Schizophrenia
a chronic disorder characterized by disturbed behaviour, thinking, emotions and perceptions
What is the hallmark of schizophrenia?
psychosis: significant loss of contact with reality
How is schizophrenia heterogenous?
Those with the disorder can differ widely in symptoms, background, response to treatment, ability to live outside the hospital, etc.
What percent prevalence of Schizophrenia is there in North America and Europe?
1% of the population
How many people suffer from schizophrenia worldwide?
Approx. 24 million
At what age to psychotic symptoms typically appear?
Mid 20’s for men. Late 20’s for women
Are there different levels of risk between genders?
Equal gender risk, but men display more symptoms earlier and more severely than women
How fast is the onset of schizophrenia?
Most often it is a slow, gradual decline in functioning. Sometimes it is acute and can lead to an acute psychotic episode within weeks
Prodromal phase
The period of gradual deterioration
Acute/Active Phase
The individual is experiencing an active psychotic episode
Residual phase
The phase following an acute phase: return to the level of functioning in the prodromal phase. No psychotic behaviour but still significant impairment
When does the historical evidence for schizophrenia begin?
Late 18th century
What is missing from descriptions of ‘madness’ (thought to include schizophrenia) prior to the 1700’s?
accounts of auditory hallucinations - common to about 70% of schizophrenia patients
What are the DSM 5 criteria for schizophrenia?
- 2 or more of these symptoms in a 1 month period:
- delusions
- hallucinations
- disorganized speech
- grossly disorganized or catatonic behaviour
- negative symptoms - Continuous symptoms for min. 6 months. Dysfunction in normal living
- Symptoms not better explained by substance abuse or other condition
Do people with briefer forms of psychosis receive a diagnosis of schizophrenia?
No, they are given other diagnoses such as brief psychotic disorder
Positive symptoms
excess or distortion of one’s normal behaviour and thoughts
What are some positive symptoms of schizophrenia?
Delusions Hallucinations Disorganized speech Disorganized behaviour (all involve a break with reality)
Negative symptoms
a lack or deficit of normal behaviour and thoughts
What are some negative symptoms of schizophrenia?
Blunted emotional expressiveness
Alogia - poverty of speech
Avolition - lack of drive/motivation
What are the most common types of delusions a schizophrenic experiences?
Persecutory
Referential
Somatic
Delusions of grandeur
Persecutory delusions
the belief that others are ‘out to get you’
Referential delusions
Believing that others are reacting to you. ie. people on TV are making fun of me
Somatic delusions
believing that one’s thoughts, feelings, impulses or actions are controlled by external forces, such as agents of the devil
Delusions of grandeur
believing oneself to be God or on a special mission
What are some common schizophrenic delusions related to thoughts?
thought broadcasting - others can hear your thoughts
thought insertion - thoughts have been planted
thought withdrawal - thoughts have been removed
Hallucinations
sensory perceptions occurring in the absence of external stimuli that become confused with reality. Can involve any of the senses
What are the most common schizophrenic hallucinations?
Auditory
Tactile
Somatic
Auditory hallucinations
hearing voices - experienced by 70% of schizophrenics
Tactile hallucinations
tingling, electrical or burning sensations
Somatic hallucinations
Specific body-related ie. ‘there are snakes crawling in my belly’
Visual hallucinations
seeing things that are not there
Gustatory hallucinations
tasting things that are not present
Olfactory hallucinations
smelling things that are not present
Command hallucinations
voices telling you what to do ie. harm yourself or others
What are the suspected causes of hallucinations?
Disturbances in brain chemistry including the neurotransmitter dopamine
How can drugs such as cocaine induce hallucinations?
Drug use can lead to increased production of dopamine
What characteristics of thought and speech are common in schizophrenics?
distortions in thinking and expression of thoughts through coherent, meaningful speech
Thought disorder
a disturbance in thinking characterized by the breakdown of logical associations between thoughts
How do attentional deficiencies affect a schizophrenic’s ability to to learn and think?
causes them to have difficulty filtering out irrelevant stimuli ie. can’t focus attention, organize thoughts or filter out unessential information
Flat effect
negative symptom: absence of emotional expression in the face and voice
Alogia
negative/emotional disturbance: a deficit or reduction in communication
Avolition
negative/emotional disturbance: lack of motivation; inability to initiate and persevere in activities
Andomonia
negative/emotional disturbance: loss of pleasure, don’t enjoy the things you used to
What happens when a schizophrenic suffers from loss of ego boundaries?
Confusion about personal identity
Failure to see oneself as a unique individual
Catatonia
people with schizophrenia become unaware of the environment and maintain a fixed or rigid posture
Waxy flexibility
when an individual allows body and limbs to be moved and then retains the new position
What changed in the DSM 5 diagnoses of schizophrenia as compared to the DSM-IV-TR?
- one of the three positive symptoms must be present
2. Subtypes were eliminated
Endophenotypes
measurable processes or mechanisms not apparent to the naked eye. The means by which an organism’s genetic code affects observable characteristics or phenotypes
What possible endophenotypes are being explored as correlated to schizophrenia?
disturbances in brain circuitry
deficits in working memory
impaired attentional/cognitive processes
abnormality in neurotransmitter function
Eye movement dysfunction is common in people with schizophrenia and…
their first degree relatives. Suggests a biomarker - genes linked to schizophrenia
How is schizophrenia explained from a psychodynamic perspective?
The ego is overwhelmed by primitive sexual or aggressive impulses from the id. These impulses threaten the ego and lead to intense intrapsychic conflict
Which Freudian stage does a person facing schizophrenia revert to?
The oral stage. Also called primary narcissism
How is schizophrenia partially explained from a learning theory perspective?
Bizarre behaviours are learned when they are more likely to be reinforced than normal behaviors
Do first degree relatives of people with schizophrenia have a different risk level of developing it themselves?
Yes, ten times mores than the general population
What mechanisms may be critical in making schizophrenia related genes active?
Epigenetic mechanisms
What prenatal factor may be linked to schizophrenia?
viral prenatal infections show possible links to increased risk of schizophrenia
What is the most prominent structural abnormality found in persons with schizophrenia?
Loss of brain tissue (grey matter)
In what area of the brains of people with schizophrenia has abnormal function and loss of brain tissue been found?
the prefrontal cortex
What is the leading biochemical model of schizophrenia?
the dopamine hypothesis: suggests schizophrenia involves an over reactivity of dopamine transmission in the brain
What is the major source of evidence for the dopamine hypothesis for schizophrenia?
the effects of antipsychotic drugs called neuroleptics
How is a negative family environment linked to schizophrenia?
Those with a genetic vulnerability could be more likely to develop schizophrenia if they are in a negative/stressful family/social environment
Communication Deviance (CD)
a pattern of unclear, vague, disruptive or fragmented communication found in the families of schizophrenia patients
What are the forms of disturbed family communication that can contribute to the development of schizophrenia?
Communication Deviance
Expressed Emotion
Expressed Emotion
a pattern of responding to the schizophrenic family member in hostile, critical and unsupportive ways
How is Expressed Emotion related to schizophrenia patients?
High EE families are less tolerant and flexible.
Patients from high EE families stand a higher risk of relapsing
How does the Diathesis-stress model view the development of schizophrenia?
as an interaction of a genetic predisposition (diathesis) with stress life factors. Especially environmental stress such as family conflict, child abuse, emotional deprivation or brain trauma/injury
What is the biological approach to the treatment of schizophrenia?
The use of antipsychotic medication to control the flagrant behaviours that disrupt normal life such as delusional thinking and hallucinations. Reduces the need for long-term hospitalization
How do antipsychotic drugs treat schizophrenia?
They block dopamine receptors in the brain, reducing dopamine activity and quelling more obvious symptoms. ie. hallucinations, delusions
What aspects of schizophrenia does treatment with antipsychotics not address?
Does not address negative symptoms and cognitive impairments
What was Freud’s belief on the use of psychoanalysis in the treatment of schizophrenia?
Traditional psychoanalysis is not suited to treatment. The client withdraws to a fantasy world and can’t form a meaningful relationship with the psychoanalyst
What problems does Cognitive Behavioral Therapy focus on in the treatment of schizophrenia?
Emotional disturbance
Psychotic symptoms
Social disabilities
Risk of relapse
What does the CBT model include in treating schizophrenia?
How to interpret environmental events
How to respond to social cues
Practice dealing with positive symptoms
What are the Learning-Based Therapy methods in treating Schizophrenia?
Reinforcement of behaviour
Token economy
Social skills training
What is ‘reinforcement of behaviour’?
A learning-based therapy model that provides or withdraws attention according to the appropriateness of the patient’s behaviour
What is ‘token economy’?
A learning-based therapy model that rewards appropriate patient behaviour with tokens that can be exchanged for goods or privileges
What is ‘social skills training’?
A learning-based therapy model in which clients are taught conversational skills and other good social behaviours through coaching, modelling, behaviour rehearsal and feedback
How do Family Intervention Programs assist in treatment of schizophrenia?
Families are trained in coping with the burden of care and developing cooperative, less-confrontational ways of relating. This reduces stress and risk of relapse for the patient.
What are other disorders that are on the Schizophrenia Spectrum?
Brief psychotic disorder - lasts a day to a month following a major stressor
Schizphreniform Disorder - last less than 6 months w/ similar features
Delusional disorder - people who hold persistent, delusional and often paranoid beliefs
What are some other forms of psychosis?
Erotomania - rare, one believes that they are loved by someone famous or important
Schizoaffective disorder - individuals who experience both severe mood disturbance and features associated with schizophrenia
